Healthcare workers (HCW) are at risk for acquiring pathogens such as Ebola virus during patient care, as recently occurred during the care of the first patient treated in a US hospital outside of a special containment unit. This proposal will address two major aspects of infection prevention to prevent the transmission of pathogens through contact: the use of personal protective equipment (PPE) when caring for patients with lethal pathogens transmitted by contact such as Ebola and hand hygiene, (HH), the most basic infection prevention measure to prevent transmission of pathogens by direct contact, but one that is not reliably performed in most healthcare settings. Appropriately donning and doffing high-level PPE is challenging and requires that HCWs adhere to a complex series of steps for every encounter, and do so correctly and consistently without self- contamination. Three projects will use a multidisciplinary approach and aim to 1) perform an integrated biological and human factors analysis of complex PPE doffing, using harmless viruses to assess for contamination (T0-T1); 2) reduce self-contamination during PPE doffing by using changes in the physical environment to improve process and flow (T1); and 3) assess different forms of feedback to improve HH compliance measured by an automated surveillance system (T0-T2). The first project will be conducted in all 5 Ebola treatment centers in Georgia, including the Emory Serious Communicable Diseases Unit and will assess vulnerabilities in the doffing process and measure contamination of PPE, then correlate these two findings. The second project will use a full-scale simulation setting and involve rapid cycle testing of prototypes to fnd design elements that improve the flow of doffing. The third project will occurs in two hospital, where HCW hand hygiene adherence will be tracked with a novel technology that also allows real-time feedback in the room; this type of feedback will compared to individual or group feedback using a staged study design, including initial assessment of system accuracy, acceptability of various forms of voice reminders and individual feedback, and periodic interviews of personnel. The work will be conducted by a multidisciplinary team from Emory University, Georgia State and the Georgia Institute of Technology and includes nurses, physicians, architects, human factors engineers, microbiologists and healthcare epidemiologists. The results from the proposed 3 projects will: 1) identify steps in the doffing protocol that are error prone; 2) create design improvements that reduce errors and the risk of self-contamination during doffing; and 3) provide pragmatic HH solutions that could be generalized to many healthcare settings. Because HH is an intervention effective against not just against Ebola but other pathogens that transmitted through contact, the public health impact may be broader than interventions focused on a specific pathogen. Overall, the results from this proposal could be immediately implemented to improve the safety of HCWs caring for patients with Ebola and prevent transmission of other more common pathogens transmitted by contact.